The truth behind nonprescription drug misuse

If you ask Robert Pelot, the restrictions placed on buying otherwise safe decongestant medicines because of the potential for misuse is just another example of a few abusers creating problems for the majority.

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But the misuse of nonprescription drugs, especially decongestants that feature pseudoephedrine, has resulted in a changed landscape for buyers and pharmacists.

Purchased in large quantities, cold and allergy medicines like Sudafed, Claritin D, Zyrtec D or Mucinex D that contain pseudoephedrine can be ground up and used to create methamphetamine, or speed, a highly addictive and illegal stimulant.

A national law now requires retailers to put restrictions on the sale of the medicines, creating a class called behind-the-counter drugs. That class also includes the Plan B contraceptive, also known as the morning-after pill.

“It’s just one more thing we have to put up with in the business,” Foster Drugs & Surgical Supplies owner Don Flowers Sr. said. “We’re getting socked with so many different regulations.”

Flowers said he has never suspected his customers of buying decongestants with the intent of misusing them.

“They’re not using it for abuse, I’m satisfied,” he said. “They’ve strictly got a stuffed-up nose or something. They really want it for a legitimate use.”

Acetaminophen, the active ingredient in Tylenol and many other pain relievers, may be next in the government’s sights. The FDA is considering putting restrictions on the sale of the drug because of a link to liver damage when overused.

Then-President George W. Bush signed the Combat Meth Act into law in March 2006. The law limited the sale of pseudoephedrine and related drugs ephedrine and phenylpropanolamine to 3.6grams per day and 9 grams per month. It also required retailers to keep the decongestants behind a counter or in a locked case, maintain a logbook of buyers’ personal information and request a photo ID.

“They (customers) don’t like it because they have to sign for it. It’s the law; I can’t do anything about it,” Pelot said.

“I got a book back there with a bunch of signatures. What am I going to do with it? If somebody wants to look at it, they can come in and look at it.”

In 2005, Walgreens began putting pseudoephedrine behind the counter in all its stores to comply with some state laws that preceded the national law.

“It’s something we decided to do on our own,” Walgreens spokesman Robert Elfinger said from the company’s headquarters in Deerfield, Ill. “We also follow any local laws that are more stringent than the national law.

“We just think it’s a necessary thing to do to do business in a responsible way.”

Local authorities say the restrictions seem to be having a positive effect.

The most recent big methamphetamine bust here came in September 2007, when several local law enforcement agencies teamed with the DEA in Operation Broken Ice to arrest 19 people in Manatee and Sarasota counties and confiscate $575,000 worth of methamphetamine.

The drug hasn’t become a big problem here, in part because of the restrictions, according to Manatee County Sheriff’s Office spokesman Dave Bristow. Marijuana and crack cocaine are still the most abused drugs locally, he said.

“We really haven’t had a huge problem with meth that has come to our attention,” Bristow said. “I think what they’ve done to make it harder to get has worked.”

The Plan B contraceptive is sold behind the counter to allow pharmacists to verify that buyers meet the minimum age requirement of 18.

Walgreens has a policy in place that allows its pharmacists whose religious beliefs run counter to the use of an emergency contraceptive to decline to dispense the medication and refer the customer to another pharmacist or another store.

“We allow our pharmacists to step away from that transaction if they’re uncomfortable with it,” Elfinger said. “Sometimes, the store manager will get involved. This is a way we can respect the beliefs of our employees.”

Acetaminophen is still available over the counter. On June 30, an FDA advisory committee recommended lowering the recommended dose for adults from 1,000 milligrams to 650 milligrams. It also recommended eliminating prescription drugs that combine acetaminophen and narcotics.

The committee did not recommend placing acetaminophen behind pharmacists’ counters. But the FDA’s final decision is months away.

Could behind-the-counter status be coming? Pelot hopes not.

“I think you just need to educate the people,” Pelot said. “You don’t take so much Tylenol, especially if you’re going to drink a lot. Both of them compete for the same liver enzymes, and you can end up on the wrong side of the ground.”